2021/2022 Collier County Clerk of Courts Expires 0 )(30-
3299 Tamiami Trail E. (Clerk's office only)
Suite 401, Bldg. F, 4th Floor
Naples, Florida 34112
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
Name b-x_y) ELF In on Date (c--
Business Name 1QQ.1S an nr1i CDn5- --1 iC lon
Business Address i °CI Enne pr15e_, Aug •
City V \L41 eprinT State FL. Zip Code •)) l
Business Telephone 3q-gel -1443 Contact Person
Lobbyist E-mail 'jen YIP kn rnrretrt ne.
Notice for Lobbyists: The annual registration fee is $25.00 per Lobbyist, per Collier County
Ordinance No. 2003-53, and amended by Ordinance 2004-05, Ordinance 2007-24 and Ordinance
2013-39. Please make payment(s) to: Collier County Clerk of Courts & Comptroller.
(Mail to the address listed at the top of the form)
NAME AND ADDRESS OF EACH CLIENT/ENTITY REPRESENTED:
1. Name SA-Ephen e VIrd*er 2. Name
Address Li-q3 Lt 'l v e . Address
City/State Nap 9 e‘,3 _ Zip 31-1 I OF) City/State Zip
3. Name 4. Name
Address Address
City/State Zip • /State Zip
(ATTACH ADDITIONAL CLIENT SHEETS,IF NECESSARY)
State of Florida
County of Collier
Lo I I gist Signature
This registration was sworn (or affirmed) and subscribed before me this Sine day of d,rd ,
20&- by Me In oi\
Personally Known , _ _ _ BY:` f
Produced ID � Y+ " PAMELAJ MNSTER Deputy Clerk/Notary Public
' `F' Notary Pubti •State of Florida
Type of ID Produced Commiasinn#NN 263412
n.;,•• My Comm.Expires Jun 14,2026
Sanded through National Notary Assn.
♦ --— 41101OPub. Revised:08/2019
Receipt# 008591430
7/6/2022 10:12:28 AM
Crystal K. Kinzel
Clerk of the Circuit Court and Comptroller
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Customer Deputy Clerk Clerk Office Location
BEN NELSON BMR CASHIER Collier County Govt. Center
NELSON MARINE MinutesandRecords@CollierClerk.co Building F, 4th Floor
CONSTRUCTION m 3299 Tamiami Trail East, Suite
10923 ENTERPRISE AVE 239-252-2646 401
BONITA SPRINGS, FL 34135- P.O. Box 413044
6864 Naples, Florida 34101-3044
1 Product
QUANTITY DESCRIPTION UNIT COST AMOUNT
1 BMR Lobbyist Registration $25.00 $25.00
TOTAL AMOUNT DUE $25.00
Check#35685 ($25.00)
BALANCE DUE $0.00
Note:
Disclaimer: All transactions are subject to review/verification. The Clerk reserves the right to correct for clerical errors and to
assess or refund charges as needed.
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